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NPI Code Detail

MEDICARE: PHILLIP SMITH

MEDICARE: PHILLIP SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLCPC-9211ID
2101Y00000XCounselor6366ID
3101YM0800XMental Health Counselor60022726WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
160022726OTHERWASTATE LICENSE

General Provider Information

NPI Number : 1992943385
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP SMITH
Provider Business Mailing Address
First Line : 611 N IRON BRIDGE WAY
Second Line :
City : SPOKANE
State : WA
Zip : 99202-4932
Country : US
Telephone Number : 509-444-8888
Fax Number :
Provider Business Practice Location Address
First Line : 1203 IDAHO ST
Second Line :
City : LEWISTON
State : ID
Zip : 83501-1940
Country : US
Telephone Number : 509-444-8888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2009
Last Update Date : 04/30/2025

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Directions to “ PHILLIP SMITH ” Practice Location

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